343605276-2-11-2020-03-CC-KGOL-BLPPR4-20200211103208

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 343605276
Report Date: 02/11/2020
Date Signed: 02/11/2020 10:32:14 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME:	BABCOCK STATE PRESCHOOL		FACILITY NUMBER:	343605276
ADMINISTRATOR:	BETTY VON WERLHOF		FACILITY TYPE:	850
ADDRESS:	2400 CORMORANT WAY		TELEPHONE:	(916) 566-1600
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95815
CAPACITY:	24	CENSUS: 15	DATE:	02/11/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Priscilla Contreras		TIME COMPLETED:	10:45 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA), Goodell met with director Priscilla Contreras for an unannounced Annual Inspection. Later during inspection, program specialist, Nicole Schlie. Facility is located at the Babcock Elementary School in portable #43. The facility’s hours of operation are Monday-Friday, 7am-5pm. LPA conducted a census of 15 children present with 3 staff. All individuals present have obtained fingerprint clearance through Twin River Unified School District. LPA observed required postings: Facility License (LIC 203A), Personal Rights (LIC9040), Emergency Disaster Plan (LIC610), Earthquake Preparedness Checklist (LIC9148), and Parent’s Rights Poster (PUB393). LPA toured all activity/classroom areas, children’s furniture, play equipment, napping equipment, food service area, and restrooms. LPA observed sign/in-sign/out sheet. Facility provides breakfast, morning/afternoon snack and lunch. LPA observed a current menu and activity posted in the entrance of the facility. LPA observed outdoor area and play equipment. Water is accessible to children both indoor and outdoor. LPA observed fire extinguisher 2A10BC, smoke and carbon monoxide detectors. LPA reviewed children files. Documents included Identification and Emergency Information (LIC700), Child’s Preadmission Health History (LIC702), Child’s Preadmission Health Evaluation (LIC701), Consent for Medical Treatment (LIC627), Notification of Parent’s Rights (LIC 995), Personal Rights (LIC613A). Report Continues on LIC-809C

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: BABCOCK STATE PRESCHOOL	FACILITY NUMBER: 343605276
	VISIT DATE: 02/11/2020

NARRATIVE

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LPA reviewed staff files and educational requirements. Documents included Health Screening Report (LIC503), TB Clearance, Personal Record (LIC501), Criminal Record Statement (LIC508), Notice of Employee Rights, Statement Acknowledging Requirement to Report Suspected Child Abuse (LIC9108) and certificate for Mandated Reporter Training. LPA observed that at least one staff member present during today’s inspection has current Pediatric CPR/First Aid that expires on 8/10/20.

LPA provided a copy of the Effects of Lead Exposure brochure. LPA discussed with the Director Assembly Bill 2370, which will require licensed Child Care Facilities to test their water for excessive amounts of lead. Testing will be required from January 1st, 2020 to January 1st, 2023 and must be conducted every five years from the initial testing.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the director can obtain updated licensing information, new regulations, self-assessment guides and access forms. LPA advised the director of their responsibility to stay current in regards to new regulations.

No Title 22 deficiencies cited. LPA reviewed report with the program specialist and provided copies. Notice of Site Visit issued and must remain posted for 30 days.

SUPERVISOR'S NAME: Bettina Engelman	TELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Kristal Goodell	TELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2020

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020

LIC809 (FAS) - (06/04)

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